CMS announces funding opportunity for the Navigator program

The Centers for Medicare and Medicaid Services (CMS) has announced a funding opportunity for the federally-facilitated exchange (FFE) Navigator program for plan year 2019. Under the 2018 FOA, CMS expects to award up to $10 million for a one-year period of performance. A minimum of $100,000 will be awarded in each of the 34 FFE states to provide assistance to exchange consumers, starting in the fall of 2018. Awards will go to eligible grantees, such as chambers of commerce, small businesses, trade associations, and faith-based organizations.

The CMS noted that enrollment data from previous years show that Navigators failed to enroll a meaningful amount of people through the FFE, and not nearly enough to justify the millions of federal dollars spent on the program. During the plan year 2018 open enrollment period, Navigators received $36 million in federal grants, but enrolled less than 1 percent of the entire FFE enrollment population. Navigators similarly enrolled less than 1 percent for plan year 2017, despite receiving a much larger $63 million in federal grants. During grant year 2016-2017, seventeen of those Navigators enrolled fewer than 100 people at an average cost of $5,000 per enrollee. In addition, nearly 80 percent of Navigators failed to reach their enrollment goal.

By contrast, agents and brokers assisted with 42 percent of FFE enrollment for plan year 2018, which cost the FFE only $2.40 per enrollee to provide training and technical assistance. To save federal dollars and provide more tailored opportunities for consumers to shop for coverage, CMS continues to expand options for individuals to enroll through the private sector, including online and in-person agents and brokers as well as enrolling directly with health insurers.

“It’s time for the Navigator program to evolve, which is why we are announcing a new direction for the program today. This decision reflects CMS’ commitment to put federal dollars for the FFEs to their most cost effective use in order to better support consumers through the enrollment process,” said CMS Administrator Seema Verma.

The new funding opportunity encourages Navigator applicants to leverage volunteers as well as strategic partnerships with public and private organizations to target consumers who would benefit from exchange coverage and more efficiently meet their enrollment goals. These changes are based on the success of private sector focused programs like those within Medicare Advantage.

Additionally, this funding opportunity includes a new requirement that Navigator funding will be based on performance from previous years to ensure accountability within the program and avoid rewarding grantees that have failed to meet performance measures. Applicants will also be encouraged to demonstrate how they provide information to people who may be unaware of the range of available coverage options in addition to qualified health plans (QHPs), such as association health plans, short-term, limited-duration insurance, and health reimbursement arrangements (HRAs). Under the funding opportunity, CMS will give priority to applications demonstrating innovative and cost-effective approaches in reaching enrollment goals.

SOURCE: CMS press release, July 10, 2018.
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